Dr. Tim Birdsall is a naturopathic physician who has spent the past twenty years as Vice President of Integrative Medicine at the Cancer Treatment Centers of America.
What is naturopathic medicine?
Naturopathic medicine is a system of medicine that relies on standard medical diagnosis and testing and uses the same kinds of techniques for evaluating patients — physical examination and standard laboratory tests and imaging studies (X-rays, CT scans, MRIs, ultrasounds) — but we’re trained primarily to look at patients through the lens of normal health and normal functioning. And as we evaluate a patient and think about how to help them deal with their health issues, we’re looking at ways that we can help their body restore the natural balance that should exist. It’s really leveraging the body’s self-healing capabilities. We don’t shy away from using drugs or other conventional medications when they’re indicated, when they’re appropriate. But we also want to use things that are going to be supportive to the body including dietary changes, lifestyle changes, and using a variety of natural products, vitamins and minerals, herbs and other kinds of natural approaches to healing. It also includes natural therapeutics, such as acupuncture, to help balance energy flow within the body. All of these things combine to create an individualized treatment plan for each person, not a “cookie cutter” approach that is typically based on a diagnosis.
If someone has hypertension, rather than just telling them to use a pharmaceutical drug, we look at the patient as a person, and we evaluate what is going on in their life and what the things are we need to manipulate, to balance, to change, in order to restore the person back to vibrant health.
Many people don’t realize how powerful the body is on its own. Can you share more about the body’s ability to heal itself?
The body really is an amazing thing. We have all sorts of healing mechanisms built in. Look at what happens to your skin when you get a small cut: the initial reaction is that there is some bleeding, followed by some inflammation and redness around it, and assuming that the cut isn’t extremely deep, in most cases, the cut heals up and completely disappears so that a few weeks later, you can’t even find the area that was impacted.
It’s just an example of the inherent ability of the body to heal. But that doesn’t mean the body can automatically resolve anything that it’s confronted with; that’s why we have medicine and physicians, and skilled healers who can do the things the body can’t do on its own. So if you have a “minor fracture,” meaning the bones are well-aligned and the bones are in close proximity to each other, in general that fracture will heal well on its own. If it’s a complicated fracture, a complex fracture, a compound fracture, where the bones are not well-aligned and there’s been damage to surrounding ligaments or tendons, the body cannot simply restore itself back into the condition it was in before the fracture occurred. A skilled physician or orthopedic surgeon may be necessary to align those bones, maybe put in a plate to hold them together to repair the ligament and tendon damage. All of those things go beyond what the body can accomplish on its own.
At the same time, even in complicated situations, the body has the ability to restore itself back to normal functioning. That’s what I try to stimulate and figure out where the barriers are that prevent the body from healing. So if it’s someone who was in an automobile accident and they’ve got a compound fracture of their leg, that’s going to require hospitalization, probably surgery with an orthopedic surgeon, and a variety of “conventional medical intervention” to get the person to a point in which the body’s healing can take over. The body still has to do the healing — that bone still has to knit back together, regardless of what the surgeon may do. The body has to do the rest of the work. So even in a situation like that, there are things that can be done to speed the mending process — all of these things can work together in a seamless plan that utilizes healthcare providers, each person doing what they do best, but what they couldn’t do solely on their own.
Why do you think an individualized approach to medicine makes sense?
One of the challenges, in my mind, with the current medical system, is that we have reduced medicine down to coming up with a diagnosis and then based on the diagnosis, assigning a therapy. Let’s take a really common condition: hypertension. You have high blood pressure, and there’s multiple categories of drugs that could be used to treat hypertension: there’s diuretics, which have been around for a long time, there’s calcium channel blockers. But at the end of the day, it’s all based on the fact that your blood pressure is too high and we need to get it low. The question I would ask is, why is the blood pressure too high?
In some cases, the blood pressure may be high because of diet and lifestyle-related issues: a person who is over-consuming salt, for example — and salt is everywhere in our diet-stream these days, particularly snack foods and fast foods. It could be related to lack of exercise, and chronic stress. And the body produces hormones, the “stress hormones” (adrenaline, cortisol and norepinephrine) in relationship to stress. A long time ago, the stress hormones functioned to prepare us for physical activity. If you think back to the prototypical caveman existence, those stress hormones in part were there to trigger the “fight or flight response.” You’re in the woods and a lion jumps out of you, and you either need to fight and defend yourself or you need to run away, and those hormones are released to allow you to do that as efficiently as the body can.
In modern society, the stress that we face is more psychological stress, and those kinds of “fight or flight” responses are inappropriate in the modern world, for that kind of stress. If you’re in a bad job situation and you have a boss that bothers you all the time, and you feel like you’re under constant stress and your job is threatened, you get the same kinds of chemicals released in the body that you would if you were confronted by a lion in the woods. But in fact, punching your boss in the nose, or turning around and running away are not functional responses (people may do that, on occasion, but it’s not a functional response)! The body is preparing itself to go into “fight or flight,” and one of the things it does is increase blood pressure as a way to get more circulation to the muscles that are going to have to empower you to run or to fight. So, hypertension may be due to chronic stress, from a psychological and an emotional standpoint.
The hypertension could also be related to other issues, such as those involving the kidneys, so it’s about taking a look at the underlying factors that contribute to this and making sure we’ve optimized everything, either before we start drug therapy or as a part of a plan that includes drug therapy, so that we’re dealing with the underlying causes of the condition, and not just treating what we see on a surface. What we see on the surface is the high blood pressure, but what are the things below the surface that we can impact?
What are your thoughts on cannabinoids and CBD?
One of the most interesting things that has occurred in medical research in the last two decades, but really, much more so in the last five or six years, is an increasing understanding of how the Endocannabinoid System works in the human body. It’s an interesting mechanism because it emcompasses many, or maybe all, the major systems in the body, and its role is really to provide a stabilizing force, what we call “homeostasis.” Homeostasis is the condition in the body that wants to maintain things at a stable condition at normal levels.
The Endocannabinoid System impacts our immune system, our endocrine and hormonal system, our neurological system, the central and peripheral nervous systems; many people are now calling the Endocannabinoid System the “master regulator” of the body. The cannabinoid receptors are located in nearly all cells in the body, and the endocannabinoid process relies on substances that are produced in the body, and also utilizes substances that we consume, that are produced by plants.
Obviously, based on the name, everyone assumes we’re just talking about the cannabis plant, which is an awesome source of external cannabinoids. But there are other plants that contain cannabinoids — like products that interact with the Endocannabinoid System — it’s not just the cannabis plant. Black pepper contains high levels of beta-caryophyllene (BCP), a terpene that functions as a cannabinoid and interacts with the Endocannabinoid System. Black truffles contain cannabinoids, which explains a lot.
Why do you think people are interested in CBD right now?
It’s a combination of things. I think the whole concept of stress and self-management of stress is an important one. The self-management piece is the most effective. The caution in all of it is, as a naturopathic physician, I still want to deal with the underlying cause. If your chronic stress is because of a bad job situation, the solution isn’t cannabis… The solution is to get a different job.
While it may be useful to use cannabinoid-containing substances to be able to manage difficult situations, at the end of the day, we have to be willing to look at ourselves, our environment, our lifestyle, and to take responsibility for that and make the changes we need to make that are in our best interest.
There are going to be situations and times when you may not be able to make that change, and you may not be able to make it quickly. For example, someone who’s in a bad marriage. Well, the right solution for your body might be to get out of that marriage, but there might be extenuating circumstances that mean that you decide that you need to stay in the marriage and need to be able to manage your stress during that time.
I do think that one of the interesting things that deserves a lot more research is around whether there are things that impact our own body’s production of endocannabinoids. I think we have the opportunity to do a lot more research on what inhibits anandamide production in the body. And what are the things in our environment or dietary patterns that reduce the amount of anandamide that we produce? Most of the endocannabinoids that we produce in the body break down very quickly, so it’s a challenging study, but it would be very intriguing.
The cannabinoids in plants can work to supplement the body’s supply of cannabinoids, if we’re not producing enough. It’s also quite likely that there are certain people who are genetically predisposed to produce lower amounts of anandamide and other endocannabinoids that would be optimal, and those people need long-term support, and that makes perfect sense. In my mind that’s no different than someone who is hypothyroid and needs to be on thyroid supplements long term, so there’s lots of opportunity for research going forward, to help us understand those individual variations.
What does “health” mean to you?
There have been some massive changes in our society over the last one hundred to one hundred and fifty years. And if you look at the entire time human beings have been on this planet, that’s just a blip of time. The reality is, prior to the industrial revolution, most people existed in groups that included a nuclear family, an extended family, and a community that had a huge degree of permanence about it. People were born, grew up, lived, married, had kids and died in the same community, surrounded by the same group of people, their entire lives... and there was a social context for our physical existence. And what’s happened, and has really accelerated in the last couple of decades, has been an increasing individual migration of people to a very mobile society, where people live some place for a few years, pack up and move somewhere else. People lose contact with where they grow up, it’s easy to lose contact with friends, and the challenge is, every time you move, you create a new circle of acquaintances. Some of them become friends, but many of them don’t and when you move away, you simply lose contact with them.
This leaves us with this sense of isolation at a foundational level, where I don’t see myself as a part of a community, and I don’t see myself as having a place in a relationship with a neighbor next door. If I know, based on my job situation, that it’s likely I’ll be moving in a few years, I may not reach out and form a friendship, because I know it will be short term And I think that creates a sense of social disconnectedness, which robs us of a huge support system. We all need support when we’re going through stressful times; we need people around us that can lift us up, whether that’s by doing something specific, saying something specific, or just being a presence that can help ground us in who we are and what our place is in the world. And as we become socially isolated, we lose that.
When a stressful situation occurs, we don’t have as many places to turn, and I think that contributes to a lot of dysfunction in society. We’ve done a lot of research in the last decade on the value of the pet’s brain in our lives. I’m a firm believer in that — as we’re talking, my dog is sitting here at my feet — and it’s not that pets don’t add value, because I believe that they do. We’ve seen people substitute pets for human interaction and human support systems, and I worry about that. Nothing against pets at all, but I think that a healthy psyche has a wide array of individuals that you can interact with, rely on, and share things with, and that’s an important stress-coping mechanism for all of us. And when you don’t have that, then all of the symptoms — both the acute and chronic symptoms of stress — start to show up.
Do you have any advice on how to best stay healthy?
It’s identical to the advice I would give to someone who was dealing with most other health problems: eat a healthy, clean diet, drink clean water, exercise regularly and take good care of your soul and your spirit, in addition to your body.
I’m excited about where we are in health in general in 2019. There are so many advances that are really breakthrough changes in the way that we think about health — in terms of not only managing disease, but also promoting wellness.